Objective: To summarize the rapid guidelines for critical care in COVID-19 patients.
The objective of the National Institute for Health and Care Excellence (NICE) guidelines is to maximize the safety of the patients who need critical care during the coronavirus disease 2019 (COVID-19).
Rapid Guidelines for Critical Care in Patients
- Assess Frailty: For patient aged 65 years, without stable long-term disabilities (e.g. cerebral palsy), learning disabilities or autism, use clinical frailty scale (CFS) score for assessment. For patient aged less than 65 years, or patient of any age with stable long-term disabilities (e.g. cerebral palsy), learning disabilities or autism, use an individualized assessment of frailty and do not use CFS score. Comorbidities and underlying health conditions should be considered in all cases.
- Decision-making on Admission to Critical Care: Critical care team should be involved in discussions about the risks, benefits, and possible outcomes of the different treatment options and admission to critical care for patients.
- If CFS score less than 5 less frail patient: Initial management should be preferred. If condition improves, ward-level care should be advised and continuously reviewed, and if condition deteriorates, patient should be referred to critical care.
- CFS score ≥5; frailer patient: Appropriateness of critical care is considered. Initial management outside critical care is advised in both the cases where critical care is suitable and not suitable.
- If critical care is considered appropriate, and condition improves on initial management, ward-level care is advised, and if condition deteriorates, patient should be referred to critical care.
- If critical care is not considered appropriate, and condition improves on initial management, ward-level care is advised, but if condition deteriorates, end-of-life care is recommended.
Reference: National Institute for Health and Care Excellence. COVID-19 rapid guideline: critical care in adults. 2020. Available from: https://www.nice.org.uk/guidance/ng159. Accessed on May 04, 2020.